Transition of Care

We understand the importance of maintaining your health coverage without any interruption in your medical treatments or prescription medications. These steps will help you make a smooth transition switching over to the Optima Health Plan.

Are you eligible for the incentive program? Action needed by June 26, 2019.

  • To receive the incentives for the Optima Health Incentive Program, you must have one of the following chronic conditions, Asthma/COPD, Diabetes, or Hypertension. If you are diagnosed with one of these conditions mid-year, or you are a new hire after July 1, you may also be eligible for some of the program benefits.
  • A completed Transition of Care Assessment must be received by by June 26, 2019 for the July 1, 2019 – June 30, 2020 plan year.

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What are your needs?

  • If have (Asthma/COPD, Diabetes, or Hypertension), what steps do I take to receive the financial incentive?

    • If you have one of the following chronic conditions (Asthma/COPD, Diabetes, or Hypertension), you may be eligible for a financial incentive. To find out complete the online Transition of Care Assessment and a clinical services represenitive will reach out to you to discuss care. Alternatively you can download the Transition of Care printable form and submit a copy by following the included instructions.

      In order to receive the incentives for the Optima Health Incentive Program, you must have one of the following chronic conditions, Asthma/COPD, Diabetes, or Hypertension, and submit the completed Transition of Care Assessment by June 26th 2019 for the July 1, 2019 enrollment year.

  • If I have a chronic condition, how do I transition care?

    • If you have a chronic condition we encourage you to fill out the Transition of Care Assessment and a clinical services represenitive will reach out to you to discuss care.
  • I currently receive obstetrics care, medical treatment, or have a procedure scheduled

    • Call your doctor's or specialist's office and tell them you are changing my coverage to Optima Health.
    • Ask your doctor to send any clinical notes and authorizations to the Optima Health Clinical Care Services team.
  • I am scheduled for treatment that required an authorization

    • Optima Health will likely need to authorize this treatment. Please contact us.
  • I need refills for my prescriptions

    • Tell your prescribing doctor you will be switching your coverage to Optima Health.
    • If possible, get your prescription refilled in advance of your change in coverage.
  • My prescription requires prior-authorization*

    • For all members newly enrolling with Optima Health currently taking prescriptions requiring prior authorization, Optima Health will temporarily waive prior authorization requirements if your prescription is filled within:
  • Your Member ID card

    • Present your new member ID card to your doctor’s office and pharmacy so they can update your records

Exclusions:*

    1. Drugs prescribed outside of any age restriction, above a quantity limit, or above sale maximum daily dosage limits.
    2. All adult stimulants.
    3. Drugs excluded by the plan such as fertility or cosmetic drugs.